Claire Dawson
Diabetes is a metabolic disorder that affects an individual's ability to produce or respond to insulin, resulting in high blood sugar levels or hyperglycemia. People with diabetes have a significantly higher chance of hospitalization due to the increased risk of complications and mortality. Hospital admission may be necessary for those with diabetes to address acute metabolic complications, newly diagnosed diabetes in children, chronic poor metabolic control, severe chronic complications, or uncontrolled insulin-requiring diabetes during pregnancy. Additionally, patients with diabetes who are hospitalized for other medical issues face a greater risk of infections and hospital readmission. Effective diabetes care in hospitals involves preadmission treatment of hyperglycemia, dedicated inpatient diabetes services, and careful transition to outpatient management.
| Characteristics | Values |
|---|---|
| Chance of hospitalization compared to those without diabetes | 3-4 times greater |
| Number of hospital discharges for adults with diabetes in the U.S. in 2020 | Over 7.86 million |
| Hyperglycemia in non-critically ill hospitalized patients | 22-46% |
| Estimated deaths per 100,000 people due to diabetes in the U.S. in 2021 | 31.1 |
| Deaths per 100,000 people with diabetes as a contributing factor in the U.S. in 2021 | 120.3 |
| Estimated total cost of treating diabetes in the U.S. in 2022 | $413 billion |
| Estimated direct medical costs of treating diabetes in the U.S. in 2022 | $306.6 billion |
| Estimated cost of reduced productivity due to diabetes in the U.S. in 2022 | $96.5 billion |
| Estimated cost per admission for type 1 diabetes in Ireland | €4,027 |
| Estimated cost per admission for type 2 diabetes in Ireland | €5,026 |
| Diabetes as a cause of hospitalization | Life-threatening acute metabolic complications, newly diagnosed diabetes in children and adolescents, substantial and chronic poor metabolic control, severe chronic complications, uncontrolled or newly discovered insulin-requiring diabetes during pregnancy |
| Blood glucose level as a criterion for hospitalization | <50 mg/dl (2.8 mmol/l) |
| Coma, seizures, or altered behavior due to documented or suspected hypoglycemia as a criterion for hospitalization | Yes |
| Impaired mental status and elevated plasma osmolality as criteria for hospitalization | Yes |
| Type of diabetes | Type 1, Type 2, Gestational diabetes, Maturity-onset diabetes of the young (MODY), Neonatal diabetes, Brittle diabetes, Type 3c diabetes |
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What You'll Learn
Diabetes management in hospitals
Diabetes is the most prevalent metabolic disorder, with an estimated 537 million adults affected worldwide as of 2021. Patients with diabetes have a 3-4 times greater chance of hospitalization than those without. This is due to the increased risk of complications and mortality associated with inpatient hyperglycemia, which affects 22-46% of non-critically ill hospitalized patients. As such, effective diabetes management in hospitals is crucial to improving patient outcomes and reducing healthcare costs.
Hospital management of diabetes should be facilitated by a dedicated inpatient diabetes service that applies well-developed standards and structured order sets. Pre-admission treatment of hyperglycemia in patients undergoing elective procedures can help reduce adverse outcomes and shorten hospital stays. Upon admission, diabetes self-management knowledge and behaviours should be assessed, and education provided if necessary. This includes skills such as medication dosing, glucose monitoring, and recognizing and treating hypoglycemia.
The American Diabetes Association (ADA) and UK Joint British Diabetes Societies (JBDS) recommend that patients with diabetes be allowed to continue using their personal continuous glucose monitoring (CGM) devices during hospitalization. They also recommend the use of confirmatory point-of-care (POC) glucose measurements for insulin dosing decisions, hypoglycemia assessment, and treatment. Structured insulin order sets, including electronic insulin order templates, can improve glycemic control without increasing hypoglycemia.
Inpatient care provided by a specialized diabetes management team can further enhance outcomes and reduce the risk of readmission. Insulin therapy is the cornerstone of inpatient pharmacological management, particularly in critical care settings. However, non-insulin drugs and combination therapy may also play a role in managing patients with type 2 diabetes. The specific glycemic goals and treatment strategies should be tailored to the individual patient's situation and explained to them accordingly.
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High risk of hospital-acquired complications
People with diabetes have a 3-4 times greater chance of hospitalisation than those without. This is due to a variety of reasons, including the risk of hospital-acquired complications.
Diabetes patients are at a heightened risk of infection, especially if they have a surgical wound that is open and healing. This is because high blood sugar creates an environment in which bacteria thrive, making it easier for wounds to become infected. As such, hospital-acquired infections are a serious concern for diabetic patients.
Furthermore, diabetes is often accompanied by other conditions, such as high blood pressure and kidney issues, which can deteriorate during a hospital stay. This deterioration can be caused by stress-induced hyperglycaemia, which is a condition where patients without pre-existing diabetes experience high glucose levels due to stress from illness and medications. This can further increase the risk of hospital-acquired complications for diabetic patients, as their blood sugar levels need to be carefully managed to prevent other health issues from worsening.
In addition, the inconsistency in the implementation of diabetes "best practice" protocols, reviews, and guidelines within hospitals can contribute to the risk of hospital-acquired complications for diabetic patients. This inconsistency can lead to suboptimal care and increase the chances of adverse events occurring during the hospital stay.
To mitigate these risks, it is recommended that patients with diabetes who are hospitalised for other medical issues closely monitor their blood sugar levels and advocate for themselves to ensure their diabetes is well-managed during their stay. Additionally, seeking diabetes self-management education during hospitalisation can help patients develop the skills needed to manage their condition after discharge, reducing the risk of complications.
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High hospital readmission rates
Hospital readmissions are a significant concern for healthcare systems, as they reflect on the quality of care provided and contribute to increased healthcare costs. Diabetes is a common comorbid condition among hospitalized patients, with approximately 9.3% of the US population affected. Notably, patients with diabetes have higher 30-day readmission rates compared to those without the condition, ranging from 14.4% to 22.7%. This disparity highlights the need to address the factors contributing to high readmission rates in this patient population.
Several factors have been identified as contributing to the high hospital readmission rates among diabetic patients. One key factor is the variability in glucose levels during their hospital stay. Studies have shown that patients with type 2 diabetes who experience wide fluctuations in blood glucose levels are more likely to be readmitted within 30 days of discharge. Additionally, inadequate glycemic control during hospitalization can increase the risk of post-discharge complications and the need for readmission.
Socioeconomic status also plays a role in readmission rates, with patients from lower socioeconomic backgrounds facing a higher risk of readmission. This may be due to factors such as limited access to healthcare services, inadequate health literacy, or challenges in managing their diabetes effectively. Addressing these social determinants of health can potentially reduce readmission rates among this vulnerable population.
Furthermore, racial and ethnic minorities are disproportionately affected by high readmission rates. While the exact reasons for this disparity are not clear, it underscores the need for culturally sensitive and equitable healthcare services. Additionally, patients with diabetes often have multiple comorbidities, which can increase the complexity of their care and contribute to higher readmission rates.
To reduce readmission rates among diabetic patients, various strategies have been proposed. These include improving inpatient diabetes education, providing specialty care, enhancing discharge planning and instructions, ensuring care coordination, and offering post-discharge support. Additionally, early consultation with a specialized diabetes team during the initial hospitalization can help reduce costs and readmission rates, as well as improve adherence to follow-up care.
In conclusion, the high hospital readmission rates among diabetic patients are a significant concern for healthcare systems. By understanding the factors contributing to these high rates, such as glucose variability, socioeconomic status, and racial disparities, targeted interventions can be implemented to improve patient outcomes and reduce the economic burden associated with readmissions. Further research and the implementation of diabetes-specific strategies are crucial to address this pressing issue.
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Diabetes medication in hospitals
Diabetes is the most prevalent metabolic disorder, affecting millions of people worldwide. Patients with diabetes have a 3-4 times greater chance of hospitalisation than those without. Diabetes was the eighth leading cause of death in the United States in 2021, and it imposes a substantial economic burden on healthcare systems.
Managing diabetes in a hospital setting can be challenging for physicians, as they must balance the use of oral medications and insulin regimens to control blood glucose levels. Uncontrolled blood glucose levels can have detrimental effects on wound healing, increase the risk of infection, and delay surgical procedures or hospital discharge. The current target blood glucose level for patients is between 140 to 180 mg per dL, with hypoglycaemia defined as a blood glucose level below 70 mg per dL.
The use of oral diabetes medications, such as metformin, in a hospital setting is controversial. While multiple guidelines recommend discontinuing these medications upon hospital admission due to the risk of renal or hepatic failure, oral diabetes medications offer important non-glycaemic benefits and can help stabilise blood glucose levels. Therefore, diabetes medications taken at home should be carefully reviewed, and only discontinued during hospitalisation if necessary.
Insulin therapy is recommended for managing hyperglycaemia in hospitalised patients. However, there is a concern that intensive insulin therapy can lead to hypoglycaemia, which is associated with increased morbidity and mortality. As such, medical professionals recommend targets that avoid this risk.
To improve diabetes management in hospitals, structured order sets and electronic insulin order templates can be utilised. These tools provide computerised advice and protocols for glucose control, helping to improve mean glucose levels and reduce the risk of hypoglycaemia. Additionally, consulting with specialised diabetes or glucose management teams can enhance patient outcomes, reduce hospital stay durations, and lower the risk of readmission.
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Diabetes education in hospitals
Diabetes is a metabolic disorder that affects the body's ability to produce or use insulin effectively, leading to high blood sugar levels or hyperglycemia. People with diabetes have a significantly higher chance of hospitalization due to the increased risk of complications and mortality associated with hyperglycemia. Hospitalization for diabetes can be necessary in several situations, including life-threatening acute metabolic complications, newly diagnosed diabetes in children, uncontrolled insulin-requiring diabetes during pregnancy, and severe chronic complications requiring intensive treatment.
Inpatient diabetes services should be tailored to the specific needs of each patient. Initial assessments should determine the type of diabetes, such as type 1, type 2, gestational diabetes, or monogenic diabetes, and the patient's diabetes self-management knowledge and behaviors. This information guides the development of individualized treatment plans and education sessions. Structured order sets and computerized physician order entry (CPOE) systems enhance the consistency and quality of diabetes care in hospitals.
Hospitals can also facilitate diabetes management by offering preadmission treatment for hyperglycemia in patients undergoing elective procedures. This proactive approach reduces adverse outcomes and improves patient outcomes. Additionally, careful transition planning from inpatient to outpatient care is essential to ensure a smooth continuation of diabetes management after discharge.
To enhance diabetes education in hospitals, it is recommended to incorporate technology, such as continuous glucose monitoring (CGM) devices, networked glucose and ketone meters, and wearable diabetes technologies. These tools enable real-time data collection and informed decision-making regarding insulin dosing and hypoglycemia assessment. However, it is important to note that access to and utilization of these technologies may vary across different hospitals and healthcare settings.
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Frequently asked questions
Diabetes is a metabolic disorder where there is an inability to produce or use insulin, leading to high blood sugar (hyperglycemia). This can cause health issues such as heart disease, nerve damage, and eye problems.
People with diabetes have a 3-4 times greater chance of requiring hospitalization due to the increased risk of complications and mortality associated with hyperglycemia. Diabetes was the 8th leading cause of death in the US in 2021.
Hospitalization may be required for those with diabetes due to life-threatening acute metabolic complications, newly diagnosed diabetes in adolescents, uncontrolled insulin-requiring diabetes during pregnancy, or severe chronic complications. Additionally, diabetes-related hospitalizations can also result from poor metabolic control, hypoglycemia, or hyperglycemia.
Yes, the American Diabetes Association provides guidelines for hospital admission. These include factors such as blood glucose levels, the presence of ketonuria or ketonemia, impaired mental status, and the need for intensive treatment of chronic complications. However, these guidelines are flexible, and other psychosocial circumstances may also dictate the need for hospitalization.
It is important to advocate for yourself during hospitalization and communicate with your care team. If you use a continuous glucose monitor or insulin pump, consult your doctor about bringing it to the hospital. Additionally, take advantage of diabetes education resources offered by the hospital, and ensure you understand the next steps and follow-up plans upon discharge.
